Data Sharing in the Age of Digital Healthcare

As the number of connected health devices skyrockets, so do opportunities for creating improved outcomes and a better patient experience. Deloitte predicts there will be 440 million wearable health monitoring devices by 2024. In addition to wearables, healthcare apps, which have been on the market for years, continue to grow in popularity. For example, the market for digital mental health apps has grown exponentially since the start of the pandemic. According to Deloitte Global, spending on these digital apps worldwide will reach $500 million this year.

Approximately 30% of data being generated in the world is generated through the healthcare industry. Each patient generates nearly 80 megabytes of imaging and EMR data each year.

Other digital health solutions with room for improved outcomes include telehealth, which experienced high growth since 2020. While most providers are back to in-person visits, the vast majority of consumers want to keep telehealth as an option going forward. Telehealth is promising in its ability to broaden access to care, especially in underserved populations like rural communities. There are 46 million Americans living in rural areas and there are fewer than 40 physicians for every 100,000 residents. Telehealth can help bring timely access to providers, specialists, and other clinicians without patients having to make long commutes to urban facilities.

The missing piece

These digital opportunities are well-positioned to improve outcomes, lower costs, and enhance the patient experience. But they’re missing one key element that is necessary to be successful: the seamless sharing of data between healthcare stakeholders.

For example, the increased popularity of telehealth has led to an increase in telehealth providers and platforms. Today there are 1,370 telehealth services companies in the U.S. Unfortunately, those companies typically do not seamlessly share data within the provider’s systems or workflows. Research shows that 60% of clinicians cannot access their telehealth platform directly from their EHR. And when patients see a telehealth provider instead of their primary care physician, the physicians may never know about the appointment unless the patient remembers to tell them. Missing information leaves providers with an incomplete picture of the patient’s health.

The situation is similar for chronic disease management. Wearable devices such as smart insoles for diabetics can alert a physician when an increase in foot temperature is detected. This can mean the patient has a foot ulcer, which is a leading cause of lower-extremity amputation in diabetics. To be most effective, providers need to be able to track, measure, and analyze that data alongside the patient’s full medical history, including A1C, blood glucose levels, and other vitals. Chronic disease management in general includes a long list of care coordinators, specialists, primary care providers, labs, payers, and others—all of whom need timely access to current data.

The benefits of digital health innovations such as telehealth and wearable health devices will never be fully realized without clinical and administrative data fluidity.

Getting innovations to market more effectively

It’s challenging for new health tech companies to launch innovative solutions for healthcare because of the way data is disjointed. Before a new digital solution can be deployed, numerous individual connections are required between EHR companies, other health vendors, and the payers or providers themselves. While FHIR standardization helps, there is still a lot of customization that must be done to create each connection.

FHIR has leveled the playing field somewhat and increased competition by enabling smaller health tech companies and startups the same access to data sets and key stakeholders as larger, legacy system companies. Regardless, data is still notoriously difficult to share and manage at scale. If the solution requires the end user—whether provider, payer, or patient—to log into multiple systems or deal with cumbersome workflows, what might be a truly innovative solution will likely struggle to scale easily and quickly.

Research shows that in 2019, more than one in every three physicians still relied solely on fax (paper or electronic) or standard mail to share patient information with providers outside their organization. Just 34% engaged in bidirectional electronic sharing of patient information.

While FHIR enables the standardization of data in a way that helps improve workflows and usability, it still requires the building and management of APIs between entities. And that means data still has to be exchanged, aggregated, and validated each time it’s used. It also does little to address issues of data ownership, control, and transparency—all of which lead to a lack of trust in the quality of the data, as well as payer-provider friction. And without the ability to seamlessly share data between entities, it is difficult to integrate new technologies in a way that lets them work together. If each solution must be accessed via separate systems, data has to be pulled out of the solution and manually entered into the provider’s systems. This does little to address today’s costly administrative inefficiencies.

What we need is a data-sharing superhighway

Disparate data from disparate solutions, no matter how innovative those solutions may be, will lead to disparate care. What we need is a digital ecosystem—a peer-to-peer network—through which healthcare stakeholders can collaborate with payers, providers, and innovators in a secure, private, dedicated environment, while still maintaining full control over their organization’s data. This could include a digital marketplace where participants could discover, offer, or source proven solutions that harness the network. Any solution could be deployed directly to other participants without the need for a third party to act as a central data authority.

This type of ecosystem would enable data from any digital solution to be accessed and used by any participant who is permissioned to access it. Common infrastructure and tools built on FHIR, blockchain, AI, and other innovative technologies, would provide the security and immutability of the data.

Once a participant connects to the network, the need to build direct connections is significantly reduced—saving millions in IT resources.

Reimagining healthcare

Imagine telehealth providers being able to facilitate a virtual visit without having to change their workflow, duplicate processes, or access separate systems. Imagine if chronic care providers could see real-time vital data from their patients’ wearable devices as part of the patient’s health record, right alongside the patient’s complete medical history. No need to download and log into individual apps and manually enter data into the EHR.

Healthcare is human and at the heart of every procedure, diagnosis, transaction, and encounter is a human being who needs care. Imagine how the seamless sharing of data could transform lives and our entire industry.

Avaneer Health is building a network to enable the type of data sharing that’s needed to fuel innovation in healthcare. The time to act is now.

Who Needs Data Aggregation? There’s a Better Way

Imagine our country without interstate highways, where each city must build its own roads to every other city. Traveling between two cities would be easy enough but traveling between 100 cities would be a nightmare. And the money and time needed to create such a micro-network infrastructure would be monumental. Yet, this is the scenario playing out every day in healthcare as hundreds of payers, providers, and vendors build one-to-one pipelines with each other to exchange data. Even then, the data has to be aggregated, normalized, validated, and combined to form a single data set, which results in numerous silos of aggregated data. It’s a far cry from true interoperability.

We need a brand new way of administering healthcare. Today, we’re trying to address our interoperability issues with workarounds, bolt-on technologies, and more APIs. To truly fix healthcare, we have to take a step back and reimagine a new way. We need to come together and look at the problem through a new lens — from the perspective of the patient and with the patient in the center. After all, healthcare is human…not merely a business process.

Reinventing the system

Instead of hundreds of one-to-one pipelines, wouldn’t it be better to have a one-to-many, decentralized, peer-to-peer network that connects all stakeholders across the country, allowing them to access information in real time? Like an interstate highway that enables true mobility without limitations, a one-to-many network enables true data fluidity. Such a network provides a conduit—a superhighway—through which payers, providers, and vendors can access the data they need when and where they need it.

An exchange is not the same as a decentralized network. The former requires data to be aggregated and validated. The latter enables full access to immutable data wherever that data lives—without the need for aggregation.

In such a network, each permissioned participant acts as a node on the network. All nodes have access to the same information at the same time and can use or reuse the data with other participants for varying purposes. And because the network is decentralized, no node can tell any other node what actions it can or cannot take, or with which entities it can or cannot share data. No single entity has the ability to control, delete, or change what other entities do.

Another benefit of this type of network is that it provides ultimate security in that there’s no longer a need to reconcile data. Each permissioned participant is the author of its own data instead of sending it to a third party (centralized); the data remains in the participant’s control (decentralized). And each participant is able to reuse the data for different purposes.

Use cases

There are dozens of use cases already identified for a decentralized network, although the potential is limitless. Coverage verification is a great example. Through a decentralized, peer-to-peer network, payerswould be able to develop the rules, processes, and analytics that provide greater standardization and insight into primary, secondary, and tertiary coverage for network participants. Through a series of preconfigured coverage pathways—or data channels—with automated workflows, coverage data would be continuously refreshed, validated, and discoverable. When a discrepancy exists, such as missing or inactive coverage data, the network could automatically inform the payer so that the information can be updated. Without a single transaction being created, the most up-to-date coverage information would always be available for any permissioned participant to access.

Prior authorization is another example. What is often an excruciating process for providers could be completed within minutes instead of days or weeks, eliminating delays in care. Prior authorization requirements would be instantly available, giving providers the ability to submit their authorization data in real time right over the network. No more back and forth between the provider and payer while patients wait.

These are just two examples that highlight the value of data fluidity. This goes way beyond automation, exchanges, and aggregation. It’s an entirely new way of doing business.

Enabling innovation

Even beyond clinical and administrative use cases, a decentralized network enables the creation of a platform of innovative and collaborative services, and a common set of tools that enhance interoperability. Hundreds of entrepreneurs enter the healthcare industry each year with an innovative idea about how to disrupt and fix healthcare’s many problems. Most don’t succeed because they weren’t prepared for the complexities our industry presents. They quickly discover that there are myriads of issues that must be addressed before they can deploy their own solutions. It’s unfortunate that hundreds of brilliant ideas go unfulfilled each year, ideas that have unlimited potential.

The fact is that true disruption can’t happen when data is isolated or aggregated in individual pipelines. A platform of services allows innovators to easily access and collaborate with other innovators, and to more quickly and effectively deploy new solutions to the marketplace. In this way, the platform becomes the foundational element of our industry’s first intentional architecture for healthcare.

Henry Ford once said, “If everyone is moving forward together, then success takes care of itself.”

The transformation has already begun

At Avaneer Health, whose founding members include Anthem (now Elevance Health), Cleveland Clinic, CVS Aetna, HCSC, IBM Watson Health (now Merative), PNC Bank, and Sentara Healthcare, we are building that network, platform, and solutions to accelerate change and lead the change to reimagine how healthcare is administered. We’ve created common utilities to ensure vital collaboration and encourage creative thinking and problem solving. We have engineered a digital ecosystem leveraging truly innovative technology that will give participants the confidence to share critical data in a way that removes traditional barriers, optimizing efficiency and laying the foundation for a completely new experience for all.

Core to our mission is to invite developers and innovators to the network to utilize our platform to accelerate the scaling of solutions for digital health, revenue cycle, analytics, value-based care, SDOH, and more. The Avaneer Network facilitates the ease and speed of connecting to multiple stakeholders across the ecosystem to enable co-creation and encourage trial and testing, supporting speed to market of much-needed innovations.

The journey forward

Data fluidity, not data aggregation, is the key to unlocking the true potential of healthcare. Instead of building more one-to-one pipelines, we need to think bigger.

While Avaneer’s focus is on reengineering the now fragmented and inefficient processes of healthcare administration, we will never lose sight of the ultimate recipient of all that we do—the human being who deserves to receive the care they need, when they need it. Unencumbered by layers of inefficient processes, together we can strive to reinvent the patient experience for good.

How to Break Down Data Silos

Positive momentum is happening in healthcare interoperability. The topic seems to garner headlines every day, with a few in our newsletter this month. It’s almost as if interoperability has recently ignited after years of moving at a snail’s pace.

I’m challenging healthcare to think differently about how we work together. More is to be gained by working together than by keeping data siloed. Achieving this type of interconnectivity requires a nationwide healthcare network that allows all participants to share information, collaborate, and launch solutions for all of healthcare. This type of digital fabric can combine disparate data for a more complete patient profile and the related administrative data needed for the business of healthcare. This level of interconnectivity can tear down the barriers in healthcare for business and people.

While there seems to be so much chaos in the world right now, it’s important that we don’t overlook the really great things happening in healthcare. It’s time to celebrate the possibilities, then roll up our sleeves and work together to make them a reality.

Stuart Hanson
CEO, Avaneer Health

In This Issue

Featured Content

Forget Micro-Networks: How Avaneer Health is Building the One Health Data Exchange

Imagine our country without interstate highways, where each city has to build its own roads to every other city. The costs and resources needed to create such a micro-network infrastructure would be monumental. Yet, this is the scenario playing out in healthcare as payers, providers and suppliers build one-to-one pipelines with each other to exchange data. There has to be a better way. Imagine our country without interstate highways, where each city has to build its own roads to every other city. The costs and resources needed to create such a micro-network infrastructure would be monumental. Yet, this is the scenario playing out in healthcare as payers, providers and suppliers build one-to-one pipelines with each other to exchange data. There has to be a better way.
Watch The Video

It’s Time to Start Innovating to Make Administrative Data Interoperable

Just as clinical interoperability creates efficiency and a better healthcare experience, greater administrative interoperability could help eliminate many of the costs related to billing and insurance. The healthcare industry needs to expand its view of interoperability to include administrative data and embrace innovation in this area.
Read More

Unblocking Interoperability with a Blockchain-Powered Network

Many of the challenges in our U.S. healthcare system could be solved through data fluidity and interoperability. We could reduce administrative costs, improve access to timely care, enhance the patient experience, and save billions of dollars each year. While efforts have been ongoing toward this end, today’s more advanced technology provides an opportunity to achieve true, industry-wide interoperability much faster.
Read More

Industry News

ONC Releases United States Core Data For Interoperability Version 3
EHR Intelligence

After receiving more than 800 public comments, the ONC has released the United States Core Data for Interoperability Version 3 (USCDI v3), which adds 24 data elements among these classes: health insurance information, health status/assessments, laboratory, medications, patient demographics/information, and procedures. The addition allows the capturing and sharing of healthcare insurance coverage in a standardized way.
Read More

Interoperability Among Office-Based Physicians in 2019
HealthIT.gov

In 2019, 65% of physicians surveyed said they exchange patient health information electronically with providers outside their organization, while 35% said they still rely primarily on fax (paper or electronic) and mail for information exchange. An even more common barrier, 85% reported challenges electronically exchanging information with providers using a different EHR.
Read more eye-opening findings from the ONC’s report on interoperability progress among physician offices.

From the Avaneer Blog

Unlocking the Full Potential of Healthcare

In an industry where new solutions often bring with them even greater complexities, the tide is—finally—turning. What started as a conversation between a tech giant and one of our nation’s largest banks has become a healthcare consortium of industry powerhouses. The goal? To create a network where all healthcare stakeholders can seamlessly collaborate, share data, and build innovative solutions to create the healthcare ecosystem of tomorrow.
Read More

Why are we still talking about administrative waste?

Are we STILL talking about administrative waste in the American healthcare system? In a word, yes. Why? There are at least 760 billion “reasons” (dollars) annually. According to the JAMA, the United States wastes almost a quarter of its healthcare spending, somewhere between $760 billion and $935 billion, including an estimated $265.6 billion on administrative complexity.

The U.S. spends more on healthcare than any other country but realizes worse outcomes than most. According to a Commonwealth Fund study from 2019, despite spending 16.9 percent of our GDP on healthcare, the U.S. ranked last among 11 industrialized countries on health case system performance measures. Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom all do better when it comes to leading long, healthy, and productive lives.

We’ve all heard the adage, the best defense is a good offense. In the game of football, that means keeping the ball away from the other team to prevent them from scoring. That may be an admirable strategy on the gridiron, but it can be devastating in healthcare.

In our game of healthcare administration, it’s payers versus providers and patient data is the football. We punt the data to the other team but work hard to keep them from holding on to it for too long. The goal is control, but it’s the patient that loses. It’s time to pick a different strategy, one built on trust and centered on the good of the patient.

What is administrative complexity?

Examples of administrative complexity are many and varied, from having to fill out forms in duplicate, rekeying existing data into a system, or managing data via fax transmissions. Most often, administrative complexity is part of billing and insurance-related (BIR) processes. These processes attempt to answer questions like:

Is this patient eligible for this service?
Can we verify the exact benefits?
Does this service need prior authorization?
Is this provider credentialled?
Is this provider part of the right network?

Some estimate that nearly half of all BIR costs are for activities that are unnecessary or duplicative. Remember the football game? To further complicate things, the referees are so nervous that one of the teams is planning on cheating (upcoding) that they keep enacting new rules. This, in turn, leads to the players looking for new creative options to “win” the game.

Why does the system work so poorly?

At its most basic level, the system is broken, and all this money is being spent on workarounds that require human intervention. The multiple, often redundant, connection points increase costs, delay care, and create personal and organizational friction. Most of the organizations involved can’t communicate directly as they have their own unique data structures and no way to share the data, even if they wanted to. (And some don’t. That proprietary data is a key business asset.)

And, of course, there is the fax. You know, technology that died out everywhere else in the 1990s. Other industries have figured out how to electronically share data securely without losing control of prime business assets. The healthcare industry is still sending faxes. Why?

The answer is deceptively simple. Remove barriers to data sharing with an inclusive network. Connect each participant and gives access to permissioned, updated data.

Going back to our football analogy: Until we play like a team, we’ll never be able to claim victory over this mess that is the U.S. healthcare system.